1477647527 NPI number — MS. DYAN L SEFTON CRNA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477647527 NPI number — MS. DYAN L SEFTON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEFTON
Provider First Name:
DYAN
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEFTON
Provider Other First Name:
DIANE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477647527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4680 OLD FOREST RD SW
Provider Second Line Business Mailing Address:
PO BOX 952
Provider Business Mailing Address City Name:
CORYDON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47112-6437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-738-7606
Provider Business Mailing Address Fax Number:
812-634-7152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 MARKET ST
Provider Second Line Business Practice Location Address:
C/O SAINT CATHERINE'S REGIONAL HOSPITAL
Provider Business Practice Location Address City Name:
CHARLESTOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47111-9553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-256-7679
Provider Business Practice Location Address Fax Number:
812-256-7419
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QA0401X , with the licence number:  28104181A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 28104181A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200103090B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28104181A . This is a "IN LICENSE NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 430072300 . This is a "MEDICARE RAILROAD #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1467530931 . This is a "SEFTON ANESTHESIA SERVICES GROUP NPI#" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000286565 . This is a "ABCBS PROVIDER #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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